‘Behavioural insights to strengthen immunisation programmes’

Flavia, GTA in pharmacy practice, attended the BISS Summer School 2019

The Wellcome Global Monitor is a worldwide study on how people perceive science and health issues. Results from this study has shown that 79% of people believe in the safety of vaccines while in the UK, this figure drops to 75%. Vaccination is a vital health intervention that saves lives by preventing vaccine preventable diseases. It is also a key strategy in tackling antimicrobial resistance, a global health threat, by reducing the need for antibiotics. Flavia, GTA in pharmacy practice, attended a summer school organised by the University of Erfurt and World Health Organisation in August. The summer school focused on behavioural insights on how to strengthen immunisation programmes by following the Tailoring Immunisation Programmes (TIP) approach. Flavia will give a talk at the Pharmacy school seminar on 3rd Oct 19 to share her learning from the summer school by presenting the core elements of the TIP process to design interventions that can improve vaccination uptake.

Recent conference presentations

Catherine Langran, Kat Hall and Dan Grant presented their work at the 10th Biennial Monash Pharmacy Education Symposium in Prato, Italy, 7-10th July.

Presentation by Catherine Langran

Catherine Langran gave an oral presentation entitled “An Evaluation of Pharmacy Undergraduate Student Wellbeing”

Authors: Catherine Langran, Pari Ajgaonkar, Mona Qassim & Alicia Pena

Congratulations to Catherine, who was awarded first prize for the best talk on Education Research at the conference.

Presentation by Dan Grant

Dan Grant presented a poster snapshot on “Peer Assisted Learning – a learning opportunity and a life hack?”

Authors: Rosemary Lim, Caroline Crolla, Daniel Grant, Taniya Sharmeen & Wing Man Lau.

 

Presentation by Kat Hall

Kat Hall presented a poster snapshot on “An Evaluation of a certificate in business administration (CBS) programme for Mpharm students”

Authors: Kat Hall, Catherine Langran & Gavin Lawrence

“Hobson’s choice or a horned dilemma”: A grounded theory synthesis of the qualitative literature examining adherence to hormone therapy in breast cancer survivorship

The winning presentation by final year PhD researcher, Othman AlOmeir, at the PhD Pharmacy Conference, April 2019, Henley Business School, University of Reading.

Othman AlOmeir
Professor Parastou Donyai, Dr. Nilesh Patel and Dr. Nicola Stoner
Reading School of Pharmacy, University of Reading, Reading, RG6 6UB. UK

Background: Depending on the researchers’ epistemological position, meta-syntheses of qualitative studies have used different approaches that include grounded theory synthesis. Numerous stand-alone qualitative studies have examined non-adherence to long-term hormonal treatment in breast cancer but no qualitative synthesis on this topic existed.

Objective: To theorise about why and how women experience non-adherence to hormonal treatment in breast cancer using published qualitative reports.

Methods: Qualitative reports were retrieved using 10 databases that included PubMed, CINAHL and PsycINFO. Primary reports written in English that encompassed qualitative descriptions of women’s non-adherence to hormonal therapy in the management of breast cancer were included. In total 21 articles published 2010-2018 were included. A first order interpretation of quotes (n= 767) in these publications was first completed and then compared against the original authors’ analyses. Quotations and interpretations were reinterpreted in NVivo using open, axial and selective coding to develop new categories. Causal conditions, actions/interactions, consequences and mediating factors were then identified for each of three emerging categories using the paradigm model.

Results: Three main categories were identified describing the 1) initial consideration of hormone therapy; 2) adhering to prescribed treatment; and 3) stopping hormone therapy. The core category explored whether and where the patient’s decision to take the medication was akin to Hobson’s choice or a horned dilemma. Hobson’s choice describes a situation where only one real viable option is offered, and encapsulates the decision
faced by many at the start of the treatment. A horned dilemma in contrast is facing two equally bad options and relates to later experiences of having to tolerate medication side effects or stop the treatment and risk losing the prophylactic cover afforded by the
medicine.

Discussion: It was possible to uncover a world of collectively shared experiences and understandings in this area by examining commonalities in existing published papers. The core category explained the difficulties women face with the initial decision to accept long term hormonal treatment and then the everyday challenge of continuing with the treatment or stopping it prematurely.

Imagining work: how healthcare workers use insulin infusions

Oral presentation by final year PhD researcher, Mais Iflaifel, at the PhD Pharmacy Conference, April 2019, Henley Business School, University of Reading.

Mais Iflaifel1
Dr Rosemary Lim1, Professor Kath Ryan1 and Dr Clare Crowley2
1 Reading School of Pharmacy, University of Reading, Reading, RG6 6UB. UK
2 Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK

Introduction: To achieve optimal blood glucose levels, intravenous (IV) insulin infusion is considered the treatment of choice for critically ill patients and non-critically ill patients who are unable to eat. An emerging approach to safety, called Resilient Health Care (RHC), proposes that it is necessary to understand in depth the variability in healthcare practitioners’ performance to help transition to a more adaptive organisation which is able to withstand every day clinical work changes and keep focus on how work can be performed successfully as well as how work has failed. This study will focus on one aspect of RHC, understanding how healthcare practitioners imagine work is performed.

Aim: To explore and understand how healthcare practitioners use IV insulin infusions based on their knowledge of related guidelines.

Methods: An analysis of eleven IV insulin infusion guidelines used at the Oxford University Hospitals NHS Foundation Trust was conducted. An inductive thematic analysis was used to analyse the content of the documents and a Hierarchical Task Analysis (HTA) was used to represent the use of IV insulin infusion in a hierarchy of goals, sub-goals, operations and plans. HTA was a way for describing the function of the goals
and activities described in the guidelines.

Results: Eight themes were identified: perform hand hygiene, identify patient, identify problem, prescribe, prepare, administer, monitor, and stop. Although the documents provided details of specific processes there were some contradictions, anomalies and lack of information. In the HTA, the top level goal is to control blood glucose in hospitalised patients using IV insulin infusion. The themes identified in the thematic analysis became the sub-goals in the HTA. For each of these sub-goals, plan(s) for operationalising them was identified. Subsequent levels in the HTA were further broken down into operations/sub goals at the lower levels and were described in terms of measurable performance
criteria.

Conclusion: A HTA was developed that showed a framework for analysing the use of IV insulin infusion. The output of the HTA was extremely useful and forms the input for the process of understanding RHC. Further research will explore how variables other than the guidelines might affect the control of blood glucose using IV insulin infusion.

Process mapping the journey of people with achalasia

Oral presentation by second year PhD researcher, Melika Kalantari, at the PhD Pharmacy Conference, April 2019, Henley Business School, University of Reading.

Melika Kalantari
Dr Amelia Hollywood and Dr Rosemary Lim
Reading School of Pharmacy, University of Reading, Reading, RG6 6UB. UK

Background
Achalasia is a rare motility disorder affecting the oesophagus. Due to the rarity of this condition, lack of information and knowledge and availability of different treatment options the management of this disease varies between individuals. Further research is required to examine the experiences of people with achalasia and its management to inform future patient care. In order to understand what people with this condition go through from when they first experience the symptoms it is important to explore their journeys through their care pathway.

Method
This study explores the patient journey of people living with achalasia and outlines the care pathway using a process map. Process mapping is an important way of understanding people’s experiences by separating the management of a specific condition into a series of steps. It helps to understand the process from the participants’ perspective and can also be used to facilitate change leading to improved quality of care. Fifteen people took part in a mapping session to share their journey and describe their experiences with achalasia. The data was then used to develop a template for the patient journey and develop a process map.

Results
Even though the onset of the disease differed between individuals, the subsequent process and steps experienced were broadly similar. Patients experienced similar symptoms at the beginning of their journey, and the majority had been sent for similar tests to obtain a diagnosis. The results of the mapping sessions indicate that most, manage their condition in similar ways, such as stress management and dietary changes. Variabilities arose between participants in terms of initial misdiagnosis and the treatments they were offered by the healthcare professionals.

Conclusion
This research maps out the patients’ journey with achalasia, which to date has not been explored. Identifying the similarities and differences in the patients’ journey highlights the gaps where an intervention, to improve patient care, could be implemented.